Introduction to Medicine, Surgery, and Medical Education by Reileyfan


									Title: Learning Theory

Author: Antoinette S. Peters, PhD

Category: General, Curriculum planning

Intended Audience: All faculty

1. To learn some basic principles of human learning
2. To apply principles to clinical training and to learning in groups
3. To begin to link these basic principles to an instructional design

Overview: Participants explore principles of learning and then relate them to medical
education. Prior to the workshop, participants read the Gawande article which describes
how a resident learns to insert a central line (a skill). At the workshop, they observe a
videotape of a baby learning to walk (a skill). Based on their observations of the tape
and their reading, they identify ways in which learning was exhibited and supported by
others. They discuss how practice, feedback, verbal learning and reflection help
learners develop deeper knowledge, skills and attitudes.

Rationale: Most adults have latent knowledge of basic concepts of learning: practice,
reinforcement, role modeling, and the like. Using cues embedded in the Gawande
article and the videotape of a child learning to walk, the facilitator elicits from the group
their understanding of learning that they may already be applying to their teaching.
From this foundation, s/he can build new knowledge. Even beginning with the
observation of learning skills at different times of life, the facilitator can address how
learning knowledge and attitudes are interwoven (e.g., learning to trust one’s teachers
when they provide a safe environment).

Resources Needed:
Gawande A. The learning curve. The New Yorker January 28, 2002: 52-61.
Perkins D. A whole new ball game. In Making Learning Whole. San Francisco, CA:
Jossey-Bass, 2009, 1-23.
Faculty: One facilitator (educator)
Materials: White board, TV/VCR player, videotape: “A Baby’s World” (excerpt: Baby
Walks; 3.5 minutes)
Handout: Suggested readings about learning; definitions of learning
Protocol: (90 minutes)

Introduction and goal setting (15 minutes) The facilitator assesses the group’s prior
experience with formal education in learning theory. S/he asks members of the group to
define learning, and writes their definitions on the board. S/he notes that there is no one
agreed upon definition of learning, but most definitions include the concept of change.
S/he then reads one or two psychologists’ definitions of learning. S/he explains that
they have undoubtedly accrued an understanding of learning over the years, even if
they are not aware of a formal knowledge of theories; and, therefore, s/he will elicit that
latent knowledge during the next exercise.

Video (5 minutes) Watch video of child learning to walk
Facilitated discussion (30 minutes) To elicit general principles, the facilitator asks: What
principles are exhibited? How do they relate to the principles exhibited in the Gawande
article? What kinds of learning are occurring (e.g., a knowledge, skill and/or attitude)? It
is likely the following principles will emerge from the discussion; however, if participants
don’t mention them spontaneously, the facilitator should probe for each one: motivation,
modeling; safe environment; practice; reinforcement; visual memory; verbal versus non-
verbal learning and how that relates to memory; recall.

Summary (10 minutes) The facilitator makes a brief presentation of learning theory,
summarizing and expanding upon the principles s/he elicited during the prior
discussion. S/he highlights two theories – constructivism and social learning theory –
because medical faculty are most familiar with these. In this presentation, the facilitator
notes the following:
   a. Learning occurs through a triadic interaction of personal characteristics, the
       environment and behavior (e.g., the baby is healthy and sufficiently mature to
       learn to walk, the environment is safe and inviting, and his mother reinforces and
       encourages his behavior). Therefore, learning is social and grounded in one’s
   b. Learning is constructed, based on prior knowledge and skills that are elaborated
       with successive experiences (e.g., the resident’s knowledge of anatomy is the
       foundation for understanding where the central line will go within the body).
   c. Different kinds of learning – verbal learning, attitudes, manual skills – require
       different approaches, which is important for teachers to understand.
   d. In summary: One needs to consider the motivation to learn and the opportunity
       to learn within a given environment; the learning experience during which
       encoding of new knowledge occurs; how memories are formed (e.g., visually,
       abstractly) and connected appropriately with prior knowledge that one recalls
       easily; how what is learned will be recalled, practiced and applied.

Curriculum planning (30 minutes) Depending upon the extent of homogeneity of
interests within the group, this exercise varies. A homogenous group undertakes
designing a teaching session together, whereas heterogeneous groups work in dyads
or triads to design different kinds of lessons. Nonetheless, the group identifies a
concept or skill that it wants to teach its students and then discusses (a) how initial
learning will occur; (b) how learning will occur over time to assure retention; and (c)
what the implications are for teaching this concept or skill.

Summary and conclusion (15 minutes) Together, the group discusses with the facilitator
the challenges they encountered in designing a piece of curriculum, whether in applying
learning theory or in determining appropriate teaching methods.

If you would like to read about how learning theory applies to medical education, see:

   1. Gruppen LD. Implications of cognitive research for ambulatory care education.
      Acad Med. 1997;72:117-120.
   1. Hewson MG. Clinical teaching in the ambulatory setting. JGIM 1992;7:76-82.
   2. Knowles MS, Holton EF, Swanson RA. The Adult Learner (5th Ed.) Houston, TX:
      Gulf Publ. Co., 1998.
   3. Mann KV. Educating medical students: lessons from research in continuing
      education. Acad Med. 1994;69:41-47.
   4. Martenson D. Learning: current knowledge and the future. Medical Teacher
   5. Norman GR, Schmidt HG. The psychological basis of problem-based learning: a
      review of the evidence. Acad Med. 1992;67:557-65.
   6. Norman G. Research in clinical reasoning: past history and current trends. Med
      Educ. 2005;39:418-27.
   7. Regehr G, Norman GR. Issues in cognitive psychology: implications for
      professional education. Acad Med. 1996;71:988-1001.
   8. TenCate O, Snell L, Mann K, Vermunt J. Orienting teaching toward the learning
      process. Acad Med. 2004;79:219-28.
   9. Wilkerson L. Learning in a clinical setting. In To Improve the Academy. Pp 120-

Good general readings about learning include:

   1. Schacter DL. The seven sins of memory: Insights from psychology and cognitive
      neuroscience. American Psychologist 1999;54:182-203.
   2. Merriam SB, Caffarella RS. Key theories of learning. In Learning in Adulthood.
      (2nd Ed) San Francisco: Jossey-Bass, 1999, pp 248-66.
   3. Perkins D. Making Learning Whole. San Francisco: Jossey-Bass, 2009.
                             DEFINITIONS OF LEARNING

“Learning is the act or process by which behavioral change, knowledge, skills, and
attitudes are acquired.” (Boyd et al, 1980)

“Learning is a change in the individual, due to the interaction of that individual and his
environment which fills a need and makes him more capable of dealing adequately with
his environment.” (Burton, 1963)

                               DOMAINS OF LEARNING

Motor skills: developed through practice
Verbal information: learned within a meaningful context
Intellectual skills: built upon prior learning
Cognitive strategies: developed through repeated challenges to one’s thinking
Attitudes: learned through human models                    (Gagne, 1972)


Adults are motivated to learn as they experience needs/interests that learning satisfies.
Adults’ orientation to learning is life-centered.
Experience is the richest source for adults’ learning.
Adults have a deep need to be self-directing.
Individual differences among people increase with age.
Adults’ motivation to learn is more often driven by internal rather than external forces.
                                                                (Knowles et al., 1998)

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